Ileal Segment Research Articles

Ileal perforation as an initial manifestation of systemic lupus erythematosus: A case report.

Introduction and importanceLupus enteritis is uncommon in patients with SLE and usually presents with anorexia, vomiting, and abdominal pain. Intestinal perforation as an initial manifestation of SLE is rare and can have a grave prognosis if not timely diagnosed.Case historyWe report an unusual case of a 22-year-old regularly menstruating female who presented with features of perforation peritonitis as an initial manifestation of lupus enteritis. Intraoperatively, a gangrenous ileal segment with multiple perforations was present. Thus, with an intraoperative diagnosis of perforation peritonitis, a gangrenous segment of the small bowel was resected and a double-barrel jejuno-ileostomy was created.DiscussionLupus enteritis manifesting initially as bowel perforation can be an uncommon cause of acute abdomen. A plain chest X-ray can show gas under the diaphragm suggesting bowel perforation. A contrast-enhanced CT scan of the abdomen is the gold standard in diagnosing lupus enteritis with a good prognosis on steroids.ConclusionPrimary closure, resection, and anastomosis of small gut or diverting stoma are required for management of perforation. A high degree of clinical suspicion is required for early diagnosis thus preventing the grave prognosis of such an entity.

V09-07 ROBOTIC INTRACORPOREAL SINGLE ILEAL INTERPOSITION FOR BILATERAL URETERAL STRICTURE

You have accessJournal of UrologyUpper Tract Reconstruction (V09)1 Sep 2021V09-07 ROBOTIC INTRACORPOREAL SINGLE ILEAL INTERPOSITION FOR BILATERAL URETERAL STRICTURE Sunchin Kim, and Matthew Gretzer Sunchin KimSunchin Kim More articles by this author , and Matthew GretzerMatthew Gretzer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002052.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral ureteral obstruction is a common complication for patients who have undergone radiation treatment for cervical cancer. Given the effect of radiation to the bladder, the usual reconstructive options are limited and becomes a challenging problem for a urologist to manage. This video aims to offer a robotic, completely intracorporeal urinary diversion using a single ileal loop interposition for bilateral ureteral strictures. METHODS: A 29 year old female with cervical cancer underwent treatment with robotic radical hysterectomy, bilateral salpingectomy, para-aortic lymph node dissection, then radiation treatment. She developed a vesicovaginal fistula and underwent repair with a pudendal thigh flap, then developed bilateral obliterative ureteral strictures at the mid-distal junction managed with bilateral nephrostomy tubes. Discussion of other options included Boari flap, psoas hitch, buccal augment, appendiceal interposition, and autotransplant. Patient was placed in a steep Trendelenburg position with four 8-mm robotic trocars placed subcostally and one assistant 12 mm port. Bilateral ureters were dissected out and transected at the level of their obliteration. The left ureter was tunneled underneath the rectum and brought over to the right side for a spatulated Wallace anastomosis. The distance between the ureter and bladder was measured, and the ileal segment was harvested. RESULTS: The operative time was 5 hours and 30 minutes. Estimated blood loss was 30 ml. Length of stay was 8 days with no complications, had extended stay for pain control given significant prior narcotics use. Bowel function and flatus were present on postoperative day 3. Foley catheter was left in place for 10 days, and bilateral ureteral stents were left in for 6 weeks. Preoperative creatinine was 0.83. Post-stent removal creatinine was 0.55. A flexible cystoscopy after stent removal revealed widely patent vesico-ileal and ileo-ureteral anastomoses. CONCLUSIONS: Complete intracorporeal robotic ileal interposition for bilateral ureters is a safe and feasible option for bilateral ureteral strictures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e689-e689 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunchin Kim More articles by this author Matthew Gretzer More articles by this author Expand All Advertisement Loading ...

Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes

The aim of the present study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. Median operative time was 270 (range 240-300) min. No Clavien-Dindo complication >2 was collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.

PD35-03 RISK OF URETEROILEAL ANASTOMOTIC STRICTURES WITH THE RETROSIGMOID ILEAL CONDUIT AFTER OPEN RADICAL CYSTECTOMY: MID-TERM FOLLOW-UP RESULTS OF A PROSPECTIVE TWO-CENTRE STUDY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-03 RISK OF URETEROILEAL ANASTOMOTIC STRICTURES WITH THE RETROSIGMOID ILEAL CONDUIT AFTER OPEN RADICAL CYSTECTOMY: MID-TERM FOLLOW-UP RESULTS OF A PROSPECTIVE TWO-CENTRE STUDY Gianluca Giannarini, Alessandro Crestani, Marta Rossanese, Giuseppe Alario, Giuseppe Mucciardi, Claudio Valotto, and Vincenzo Ficarra Gianluca GiannariniGianluca Giannarini More articles by this author , Alessandro CrestaniAlessandro Crestani More articles by this author , Marta RossaneseMarta Rossanese More articles by this author , Giuseppe AlarioGiuseppe Alario More articles by this author , Giuseppe MucciardiGiuseppe Mucciardi More articles by this author , Claudio ValottoClaudio Valotto More articles by this author , and Vincenzo FicarraVincenzo Ficarra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously compared the perioperative and short-term follow-up results of retrosigmoid ileal conduit without contralateral transposition of the left ureter versus traditional ileal conduit after radical cystectomy (RC) in a single-surgeon series, and observed a significantly reduced ureteroileal anastomotic stricture (UAS) rate with the former. In this study, we assessed perioperative outcomes, complications and, in particular, UAS rate at a longer follow-up in a larger, two-centre, two-surgeon cohort of patients receiving retrosigmoid ileal conduit after RC. METHODS: Between 03/2016 and 06/2020, 97 consecutive patients (median age 75 years) underwent open RC and retrosigmoid conduit using a 20-cm long ileal segment at two academic centres within a prospective study. Two expert high-volume surgeons performed all cases. Ureteric catheters were removed on postoperative day 7 and 8. All patients were followed with ultrasound examination of abdomen/pelvis at 3 months, CT of abdomen/pelvis at 6 and 12 months after surgery, and then CT yearly for 5 years or when clinically indicated. UAS was defined as any upper urinary tract dilatation requiring endourological or surgical management. Operating room time, estimated blood loss, and 90-day postoperative complications classified according to the Dindo-Clavien system were assessed. In particular, UAS rate and side was evaluated. RESULTS: Median operating room time was 245 (interquartile range [IQR] 215-290) min, median estimated blood loss was 350 (IQR 300-500) ml, and blood transfusions were given to 15 (15.5%) cases. No intraoperative complications were observed. Ninety-day postoperative complications were observed in 33 (34%) patients, being major (grade 3-5) in 19 (19.6%) cases. Two patients died of early postoperative complications. No single case of ureteroileal anastomotic leakage or any urinary fistula was observed. At a median follow-up of 25 (IQR 14-40) months, only one case (1%) of UAS was observed, involving the right ureter of an obstructed kidney and requiring an open ureteroileal reimplantation. CONCLUSIONS: We showed that retrosigmoid ileal conduit is a safe and valid option in patients undergoing non-continent urinary diversion after RC. Of note, UAS rate is very low with this technique, mainly due to the preservation of naïve location of, and blood supply to, the left ureter without transposition to the contralateral side. Further studies are warranted to confirm our very good results. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e589-e589 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gianluca Giannarini More articles by this author Alessandro Crestani More articles by this author Marta Rossanese More articles by this author Giuseppe Alario More articles by this author Giuseppe Mucciardi More articles by this author Claudio Valotto More articles by this author Vincenzo Ficarra More articles by this author Expand All Advertisement Loading ...

Small bowel obstruction caused by a true ileo-ileal knot: a rare case successfully treated by prior ligation of mesenteric vessels

BackgroundIntestinal knot formation, in which two segments of the intestine become knotted together, can result in intestinal obstruction. An ileo-ileal knot refers to knot formation between two ileal segments and is a very rare benign disease. We report a case of strangulated bowel obstruction caused by true ileo-ileal knot formation.Case presentationAn 89-year-old woman was referred to our hospital with the diagnosis of intestinal obstruction. Contrast-enhanced computed tomography revealed the small bowel forming a closed loop, with poor contrast effect. Based on the findings, the patient was diagnosed as having strangulated bowel obstruction, and emergency surgery was performed. At laparotomy, two segments of the ileum were found to be tied together forming a knot, and both segments were necrotic. Although it was necessary to release the strangulated small bowel, we did not immediately release the knot, but first proceeded with ligation of the mesenteric vessels to the strangulated small bowel to prevent dissemination of toxic substances from the necrotic bowel into the systemic circulation. The surgery was completed with resection of the necrotic ileum and anastomosis of the small intestine. The postoperative course was uneventful, and the patient was discharged home.ConclusionWe encountered a case of strangulated bowel obstruction caused by true ileo-ileal knot formation. Resection of the necrotic small intestine without releasing the knot could be performed safely, and might be considered as an option of surgical procedure.

Reoperation for Channel Complications in Children With Continent Cutaneous Catheterizable Channels: The Test of Time

ObjectivesTo examine the durability of continent cutaneous catheterizable urinary channels (CCCC) in children and assess whether channel complications continue to arise with extended follow-up. Previous studies demonstrated that complications of CCCC cluster in the early years following surgery. MethodsThe database of a tertiary center was queried for patients≤21 years who underwent CCCC. Patients with <6 years of follow-up were excluded. Patients were invited for follow-up to assess continence. Clinic visits and hospital admissions were reviewed for channel complications requiring reoperation. Complications were analyzed against patient and channel characteristics and time since initial surgery. ResultsBetween 1993 and 2012, a total of 120 patients underwent CCCC at a median age of 6.8(0.4-21) years and a median follow-up of 11.4(6.6-27) years. CCCC were created using the appendix, Monti channels and tapered ileal segments in 74(61.7%), 33(27.5%) and 13(10.8%), respectively. Continence relied on the extra-mural serous lined principle in 85.8% and the stoma was anastomosed to the umbilicus in 90%. Dryness with catheterization intervals of 3 hours or longer was eventually achieved in 90.8% with similar rates among different channel types (P=.149). 26(21.7%) required 42 interventions to treat channel complications with 32.5% occurring >5 years following initial surgery irrespective of the channel type (P=.978). On multivariate analysis, ileal channels had 3.372 higher odds of needing reoperation compared to appendicovesicostomy (95%CI=1.240-9.166; P = .037). ConclusionA high reoperation rate is anticipated throughout the lifetime of CCCC. Appendicovesicostomy has a low complication risk relative to ileal channels.

A tissue-engineered urinary conduit in a porcine urinary diversion model

The use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant’s remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.

Characterization of the bacterial microbiota across the different intestinal segments of the Qinghai semi-fine wool sheep on the Qinghai-Tibetan Plateau.

ObjectiveThe intestinal microbiota enhances nutrient absorption in the host and thus promotes heath. Qinghai semi-fine wool sheep is an important livestock raised in the Qinghai-Tibetan Plateau; however, little is known about the bacterial microbiota of its intestinal tract. The aim of this study was to detect the microbial characterization in the intestinal tract of the Qinghai semi-fine wool sheep.MethodsThe bacterial profiles of the six different intestinal segments (duodenum, jejunum, ileum, cecum, colon and rectum) of Qinghai semi-fine wool sheep were studied using 16S rRNA V3–V4 hypervariable amplicon sequencing.ResultsA total of 2,623,323 effective sequences were obtained, and 441 OTUs shared all six intestinal segments. The bacterial diversity was significantly different among the different intestinal segments, and the large intestine exhibited higher bacterial diversity than the small intestine. Firmicutes, Bacteroidetes, and Patescibacteria were the dominant phyla in these bacterial communities. Additionally, at the genus level, Prevotella_1, Candidatus_Saccharimonas, and Ruminococcaceae_UCG-005 were the most predominant genus in duodenal segment, jejunal and ileal segments, and cecal, colonic, and rectal segments, respectively. We predicted that the microbial functions and the relative abundance of the genes involved in carbohydrate metabolism were overrepresented in the intestinal segments of Qinghai semi-fine wool sheep.ConclusionThe bacterial communities and functions differed among different intestinal segments. Our study is the first to provide insights into the composition and biological functions of the intestinal microbiota of Qinghai semi-fine wool sheep. Our results also provide useful information for the nutritional regulation and production development in Qinghai semi-fine wool sheep.

Primary antiphospholipid antibody syndrome presenting as acute superior mesenteric vein thrombosis

Antiphospholipid antibody syndrome (APS) is an autoantibody mediated thrombophilia characterised by recurrent arterial or venous thrombosis and/or pregnancy morbidity. APS presenting as thrombosis in mesenteric venous system is relatively uncommon (10%). Here, we present a case of primary APS presenting as acute superior mesenteric vein (SMV) thrombosis in a 38-year-old female. She was admitted with the complaints of abdominal pain and constipation for five days. Her abdomen was distended with sluggish bowel sounds. Her abdominal contrast enhanced computed tomography revealed thrombosis of SMV, splenic vein and portal vein. She was initially kept on conservative management and started on anticoagulants. Her coagulation work-up revealed that she was positive for anticardiolipin antibody and therefore, the diagnosis of APS was made. She was continued on conservative management and anticoagulants. On the tenth day of admission, after starting oral diet, she developed severe abdominal pain and abdominal signs of peritonitis. She was then taken up for emergency laparotomy. Intraoperatively; there was 100 cm of gangrenous ileal segment, about 60 cm from ileocecal junction and 160 cm from duodenojejunal flexure. The gangrenous ileal segment was resected and a double barrel ileostomy was constructed. She had an uneventful postoperative recovery and was started on lifelong anticoagulants.

Evaluation of Upper Urinary Tract Integrity After Radical Cystectomy and Orthotopic Diversion with Ileal and Sigmoid Neobladder.

The study aims to evaluate the effects of orthotopic urinary diversion using ileal and sigmoid segments after radical cystectomy on upper urinary tract function and morphology. A retrospective study included 60 patients divided into 2 equal groups (W-ileal pouch group and sigmoid pouch group). We assessed renal function and morphology post-operative after 6months and after 1year by serum creatinine, ultrasound, IVP, pouchogram, and renal scan study. After 6months post-operatively, in the W-ileal group, there were 16 renal units (26.6%) deteriorated in morphology and 11 renal units (18.4%) deteriorated in function. After 1year, further deterioration in morphology was noted in 17 renal units (28.3%) and in function in 16 renal units (26.7%). In the sigmoid group, after 6months post-operatively, there were 14 renal units (23.3%) deteriorated in morphology and 14 renal units (23.4%) deteriorated in function. After 1year, further deterioration in morphology was noted in 47 renal units (24.4%) and in function in 18 renal units (30%). Incorporating the bowel into the urinary tract is potentially dangerous to the upper urinary tract's integrity, and the leading cause of renal impairment is uretero-pouch obstruction.

Application of the “Yang-Monti principle” in children with iatrogenic ureteral injuries

Iatrogenic ureteral injuries in children are rare, due to its retroperitoneal position. The Yang -Monti ileal substitution serves as a good surgical option in such injuries associated with long segment defects of the ureter. To review our experience using the Yang Monti principle of ileal ureter substitution in children with long segment ureteric defects and analyse its intermediate term outcomes. This was a prospective study, conducted from 2014 to 2019. All children with iatrogenic ureteral injuries with delayed presentations, undergoing the Yang Monti principle of ileal ureter substitution, were included (as illustrated in summary image). These injuries were divided into upper, mid, and distal ureteral injuries and were diagnosed based on a standardized protocol. At follow up, findings of the CT urogram, functional isotope renogram, and renal functions were the key points monitored. The demographic, clinical profile, operative, post-operative complications and follow up data were collated and analyzed. 22 children were diagnosed with iatrogenic ureteral injuries. Of these, 14 children with delayed presentations underwent the Yang Monti principle of ileal ureter substitution. The primary pathology was gangrenous appendicitis (9 cases), calculus cholecystitis (3 cases) and torsion ovary (2 cases). Laparoscopic procedures were the commonest approach for the injury (10). The average age was 11.5 years, with a male predominance. The right ureter was affected in 12 cases. The average time to detection was 7 days. All children underwent an ultrasound guided nephrostomy tube insertion at presentation and the mid ureter (9) was most affected. The mean length of ureteric injury was 3.75cm. Intra operatively, one ileal segment (2), two ileal segments (11) and three ileal segments (1) were used according to the length of the ureteric defect. Complications were urinary tract infections (2), adhesions (3) and leak (2) which were conservatively managed with no redo surgeries. The median follow up period was 4 years. At follow up CT urogram and isotope diuretic renogram were normal, with preserved renal functions and no metabolic complications in all. In children associated with iatrogenic ureteral injuries of long lengths, the "Yang Monti ileal substitution" serves as a good and simple option with lesser complications permitting the preservation of the renal function at follow up.

Кишечная и аппендикулярная реконструкция мочеточников

Aim To present the technical features and results of intestinal and appendicular ureteral replacement. Material and methods From 1998 to 2020, a total of 196 patients aged 18 to 77 years (mean age 49.5 +/- 1.2 years) were undergone to intestinal and appendicular ureteral reconstruction in our clinic. There were 123 women (62.8%). The most frequent indications for surgery were complications of open and endoscopic ureteral procedures, radiation-induced ureteral stricture, and iatrogenic injuries of the ureters during gynecological and surgical interventions (81.6%). In 165 (84.2%) patients, for ureteral replacement the ileal segment was used, while in 4 (2.0%) and 27 (13.8%) cases the colon segment and the appendix were chosen, respectively. Unilateral ileal ureteral replacement was performed in 131 (79.4%) cases, while in 34 (26.6%) patients a bilateral procedure was done. Partial and complete ureteral replacement was performed in 107 (81.7%) and 24 (18.3%) cases, respectively. Laparoscopic intestinal and appendicular ureteral replacement was performed in 44 (22.4%) patients, while two patients were undergone to robot-assisted procedure (1.0%). Results Early postoperative complications were noted in 17 (8.7%) cases. The most severe included acute bowel obstruction, leakage of entero-ureteral anastomoses, necrosis of the ileal graft and bleeding in 10 (5.1%) patients. In all cases, repeat intervention was performed. There were no lethal complications. Late postoperative complications developed in 24 (14.3%) patients. Conclusion Today our clinic has the worlds largest experience in intestinal and appendicular ureteral reconstruction, including original procedures, confirmed by 5 patents for inventions. The minimum number of postoperative complications, the absence of deaths and good long-term results provide the basis for the introduction of ileal and appendicular ureteral replacement into clinical practice.

Involvement of TRPV1 and TRPA1 in the modulation of pacemaker potentials in the mouse ileum

BackgroundThe roles of transient receptor potential cation channel, subfamily V, member 1 (TRPV1) and subfamily A, member 1 (TRPA1) in mechanisms of gastrointestinal motility are complex. This study aimed to clarify the effects of several TRPV1 and TRPA1 ligands on the electrical potentials generated by pacemaker cells in the mouse-isolated ileum. MethodThe pacemaker potentials of ileal segments of mice were recorded extracellularly using a 60-channel microelectrode array. The dominant frequencies, average waveform periods and propagation velocities were quantified. The effects of TRPV1 and TRPA1 agonist and antagonist were compared with the baseline recordings. ResultsThe electrophysiological recordings showed that capsaicin (30 μM to 3 mM), resiniferatoxin (300 μM), capsazepine (100–300 μM), allyl isothiocyanate (300 μM), isovelleral (300 μM), icilin (300 μM), A-967,079 (10 μM), AP18 (20 μM) and HC-030,031 (50 μM) significantly reduced the pacemaker frequency and increased the waveform period relative to the baseline. Conversely, ruthenium red (300 μM) significantly increased the pacemaker frequency and reduced the waveform period. Capsaicin (3 mM) and AP18 (20 μM) also significantly reduced the propagation velocity. However, all tested antagonists failed to inhibit the effects of agonists. AMG9810 (300 μM), but not A-967,079 (300 μM), significantly inhibited the increases in pacemaker frequency caused by increased temperatures. ConclusionOur findings suggest that TRPV1 and TRPA1 play a minor role in regulating pacemaker potentials and that at non-specific actions at other TRP and ion channels most likely contributed to the overall effects on the electrophysiological recordings that we observed.

The combination of quillaja and yucca saponins in broilers: effects on performance, nutrient digestibility and ileal morphometrics

ABSTRACT 1. Two series of studies were conducted to determine the effects of a combination of ground plant material derived from Quillaja saponaria trees and Yucca schidigera plants (QY) as sources of saponin, on performance, productivity, nutrient digestibility and ileal morphology of growing broilers. In each trial, 480 Cobb male birds were allocated equally to 24 pens at one-day-of-age according to body weight 2. The studies consisted of two identical floor pen trials in which performance and nutrient digestibility were assessed and two trials where performance and ileal morphology were determined. In each trial, 0, 250 or 500 ppm QY were included in feed given to the broilers from 1–35 or 1–42 d of age, respectively. Eight (digestibility) or 12 (morphology) randomised replicate pens were used. 3. In the digestibility trials, two birds per pen were moved to metabolism cages at d 21. Excreta was collected for a five-day period (d 21 to 25) for the determination of apparent total tract digestibility of dry and organic matter, fat and ash and nitrogen retention. For intestinal morphology, ileal segments were collected from four birds/pen on d 21 to determine villus height and crypt depth. Performance data were collected in each trial series. 4. Results showed that feeding graded levels of QY produced significant linear improvements in performance and productivity at d 35, and similar linear effects were observed for N retention and all apparent digestibility measurements. Morphology data showed that birds receiving 250 and 500 ppm QY had significantly increased villus height 5. These results indicated that QY exerted a positive influence on the intestinal tract by increasing the absorptive surface and improving nutrient digestibility. These effects were considered to be associated with the performance improvements recorded in both experiments.

Robotic assisted ileo-vaginoplasty for vaginal atresia

Vaginal agenesis is a rare congenital disorder of female genital tract. Vaginal reconstruction using bowel segment is usually offered last when dilatation and/or prior vaginal reconstruction attempts using graft or flap has failed. Traditionally accomplished using open surgical approach, we describe here our initial experience of robotic-assisted ileo-vaginoplasty. The index patient presents to us with inadequate vaginal depth after failed buccal mucosal graft vaginoplasty. With the patient in low lithotomy position, port placement and docking of the robot was done. Isolation of ileal segment, closure at its proximal end and end-to-end bowel anastomosis was accomplished successfully. However, in view of dense adhesions the subsequent pull-down of the ileal segment into the perineum could not be done safely. The procedure was completed using combined abdomino-perineal open approach. A vaginal stent (in the ileal segment) and a catheter (in the introitus) were placed post-operatively. Post-operative recovery was uneventful. At 2-weeks, 3 months and a subsequent 1 year follow-up Cystoscopy and examination under anesthesia revealed an adequate vaginal depth with patient reporting successful vaginal dilatation. Robotic reconstruction of vagina using bowel segment in select patient, is safe and feasible, but possible with formidable surgical experience.

Cinnamon bark oil and coconut oil emulsions modified small intestinal motility and barrier function in laying hens in an ex vivo experiment

ABSTRACT 1. Plant extracts and oils are supplemented in diets for chickens due to their antimicrobial capacities; however, little information exists whether they influence intestinal motility and barrier function. 2. The present study aimed to determine the effect of increasing levels of cinnamon bark oil (CBO; 0%, 0.038%, 0.076% and 0.151%) and coconut oil emulsions prepared with soy and sunflower lecithin on the contractile function of enteric wall muscles in the jejunum and ileum and jejunal barrier function in laying hens. 3. For testing muscle contraction, mid-jejunal and ileal segments (n = 4 each per hen) from four laying hens were placed in a longitudinal orientation into isolated organ baths filled with Krebs buffer and fastened to force transducers. Muscle segments were induced to contract with acetylcholine and the effects of the oil emulsions on contraction were measured. 4. For barrier function, distal jejunal pieces were stripped of serosa before mounting into Ussing chambers and recording changes in short-circuit current (ISC) and transepithelial tissue conductivity (GT) before and after addition of the respective emulsion. 5. The CBO decreased the muscle tone, representing a relaxation of on average 36.2% and 42.6% for the jejunum and ileum, respectively, compared to before the addition (P < 0.001). Moreover, CBO linearly decreased the ISC and GT of the jejunal mucosa, indicating a greater absorption of anions and increased barrier function (P < 0.001). Only the coconut oil-sunflower lecithin emulsion relaxed the muscles, whereas both coconut oil-lecithin emulsions increased the ISC but reduced the GT of the jejunal mucosa, which suggested an increased cation absorption and decreased paracellular permeability, respectively (P < 0.05). 6. In conclusion, CBO and coconut oil-lecithin emulsions showed the potential to increase jejunal barrier function, whereas CBO may be more efficacious to slow down digesta passage in the small intestine.

Luminal polyethylene glycol solution delays the onset of preservation injury in the human intestine.

The organ damage incurred during the cold storage (CS) of intestinal grafts has short and long-term consequences. Animal studies suggest that additional luminal preservation (LP) with polyethylene glycol (PEG) may alleviate this damage. This study aims to validate these findings using human intestines. Ileal segments, perfused intravascularly with IGL-1 solution, were procured from 32 multiorgan donors and divided into two parts: one containing a PEG 3350-based solution introduced luminally (LP group) and another one without luminal treatment (control). Sampling was performed after 4h, 8h, 14h, and 24h of CS. Histology was assessed using the Chiu/Park score. Tight junctions (TJ), several inflammatory markers, and transcription factors were examined by immunofluorescence, ddPCR, and western blot. Tissue water content (edema) was also measured. Apoptotic activity was assessed with caspase -2, -3, and -9 assays. LP significantly lowered mucosal injury at all time points. Redistribution of TJ proteins occurred earlier and more severely in the control group. After 24h of CS, LP intestines showed an emerging unfolding protein response. Increased caspase-3 and -9 activity was found in the control group. The current results indicate that luminal PEG is safe and effective in reducing damage to the intestinal epithelium during CS.

Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes.

Background Aim of the study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations. Methods Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients' baseline characteristics, as well as, perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences. Results Median operative time was 270 (range 240-300) min. No Clavien-Dindo complications >2 were collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found. Conclusions Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.

Study of modified technique of ileal neobladder-Frog neobladder.

Purpose:Orthotopic neobladder is a well-established technique for continent urinary diversion after radical cystectomy. In this study, we evaluated a new Frog ileal neobladder technique. Since the reconstructed neobladder appears like a frog, the name Frog Neobladder was given to it. We have used two isoperistaltic ileal segments and implanted ureters in the nondetubularized proximal end of the ileal segment.Subjects and Methods:This was a prospective, single-center (tertiary care hospital) study conducted from February 2008 to January 2018. Study patients were aged 39–94 years with biopsy-proven muscle-invasive localized bladder carcinoma. One hundred and twenty patients were included in the study, who had undergone Radical Cystectomy and were offered “FROG BLADDER”– a type of neobladder. Evaluation of complications, renal function, urodynamic parameters, post-void residual urine (PVR), continence, and need for clean intermittent catheterization was done in all patients with neobladder.Results:A total of 120 patients were included in the study, the average age of the patients was 62 years. The operative mean time was 280 ± 29.8 min. There was no perioperative death, and perioperative or early and late complication rates were 31.2% and 18.7%, respectively. Six patients had uretero-enteric anastomosis stricture, of which two were managed by retrograde ureteroscopic dilatation, another three strictures were treated with antegrade approach, and one patient underwent open surgery. All patients were able to void urine, except for three patients who required self-catheterization. The mean capacity was increased to average of 398 ± 220 ml at 12 months in all patients. The mean PVR at 1 year was 46 ± 54.4 ml.Conclusion:The Frog neobladder has similar outcome similar to other neobladder technique, with added advantage of ability to accommodate shorter ureteric length and the ease of accessing ureter by retrograde approach for intervention.

Orthotopic ileal neobladder creation according to the original surgical method “Belgrade pouch“ - a ten-years experience

Background/Aim. The principle of continent urinary derivations is based on the formation of a reservoir as similar as native bladder is, with satisfactory capacity, high level of continence, low pressure and small resorbent surface as possible to prevent metabolic disorders. Methods. This prospective and partially retreospective study included 148 patients with organ confined muscle invasive bladder cancer, operated on in a ten-year period, and followed up in a 3-year period. After a radical cystectomy, an original surgical technique of creating ?U? shaped orthotopic neobladder using a short ileal segment, average length of 30 cm, called ?Belgrade pouch?, was performed. Results. The results of 126 male and 22 female patients, three years following the surgery, showed average pouch capacity of 477 (330?659) mL, insignificant residual urine of 52 (0?92) mL, and the averageurinary frequency was five times within 24 h. Day time continence was present in 90% of patients and nighttime continence in 88% of patients, 7% of patients had mild acidosis, and 3% of patients had vitamin B12 deficiency. Conclusion. The neobladder created according to the ?Belgrade pouch? technique showed excellent results comparabile with standard techniques, with adequate capacity, high continence rate, favourable 24 h voiding frequency, insignificant residual urine, and a significantly lower rate of metabolic complications during the 3 years of the follow-up period.